Reproductive Health Supplies Coalition (RHSC) Market Development Approaches (MDA) Working Group – Working with Industry Consultative Forum Arlington, USA October 2007 John-Heyns Ferreira What makes effective partnerships work – A Southern African Experience of Market Development Approaches

SOUTH AFRICA AND AFRICA – Developing Territories  Typically these areas have poverty related problems such as - High fertility rates - High maternal, infant and morbidity rates - A well known fact is the correlation between contraceptive prevalence, maternal mortality, abortion rate and infant mortality  It is often believed that local manufacturing may aid in solving these and this is where Fresenius Kabi South Africa is ideally positioned for certain African countries and possibly a number of others.  Being favourably graphically located the company goes far to ensure availability, accessibility and generically affordably.  In addition, the national environments of several countries are already under control as well as demand creation and supply management.  Fresenius has for a number of years successfully forecasted, manufactured and delivered sufficient supply its high quality contraceptive to these very markets.

PETOGEN “ Effective and Cost-Effective Contraceptive ” AN EXAMPLE OF SAME TRAINING and ADVERTISING IN SEVERAL Lower and Middle Income Countries (Botswana, Namibia, Lesotho and Swaziland) ~ Duplicate Advertising Campaigns

Training Points for Discussion  Product description  Mechanism of action  Benefits of using Petogen  Cost-effectiveness of Petogen  Side effect profile  Myths around use of Petogen  WHO guidelines on injectables

Product Description  An injectable contraceptive for long-term use  Available in 1 ml vial containing 150mg of medroxyprogesterone acetate (DMPA)  Supplied as an aqueous microcrystalline suspension

Mechanism of Action Suppress ovulation Change endometrium making implantation less likely Thicken cervical mucus preventing sperm penetration

DMPA Mode of Action A:DMPA inhibits ovulation. B:DMPA causes changes in the endometrium. C:DMPA alters cervical mucus. A B C

Effect of Depot Contraceptives on the Menstrual Cycle

Benefits of using Petogen Highly effective Is reversible and safe Is given 4 times a year, thus Making it Convenient for … Clients Staff It is Cost-Effective!

Side Effect Profile  Menstrual changes  Slight weight gain

Myths about Petogen  “It cannot be given to the youth” Petogen can be used for all age groups, including the youth  “It causes sterility and fertility” Petogen does not cause sterility as it is reversible

WHO and National Contraceptive Guidelines  The following women can use Petogen as per WHO & National Contraceptive Guidelines:  Young women  Women over 40 years  Women who are breast-feeding  Women who are HIV+  Women who suffer from TB, malaria & diabetes  Women who smoke

Fresenius-Kabi’s Commitment  Same goals as the Department of Health:  To ensure that all clients Young and Old have the right to make a choice with regards to a method  To increase public knowledge of our method  To provide a high-quality contraceptive method  To increase awareness of the use of Condoms to fight against STD’s and HIV

ENSURING CONTRACEPTIVE SECURITY AND PRODUCT SUPPLY  Pivotal is Relationship building and trust in relevant authorities  Country Family Planning programmes need to be understood and followed where possible  Balance supply and demand by continued consultation  Co-operate in Capacity building – finance, forecasting, procuring and distribution  Governments commitment and partnerships  Ongoing communication and co-ordination

ENSURING CONTRACEPTIVE SECURITY AND PRODUCT SUPPLY  Fresenius Kabi is a generic hormonal manufacturer of a high quality product  Production facilities, procedures and systems are continually being upgraded and updated to ongoing international specifications  Additionally relationships and partnerships continue to be built

SOME MARKETING AND ADVERTISING TOOLS USED  Posters and detail aids indicating - Efficacy - Minimal usage - Honesty - Dependability - Say “Yes to” - Patient information leaflet - Selection Criteria

Only 4 times a year. For parous and nulliparous 99.9% effective Prevents unplanned pregnancies

POSTER IN EVERY CLINIC

EACH PATIENT RECEIVES OWN BOOKLET AS A PATIENT INFORMATION LEAFLET ~ several languages

DMPA is indicated for women with a normal menstrual cycle, who, for various reasons cannot take oral contraceptives regularly and those whose medical status precludes use of contraceptive doses of oestrogen:  Parous / nulliparous women  5 days postpartum if not lactating  6 weeks postpartum if lactating  Women who want maximum protection  Women who want reversible contraception SELECTION CRITERIA FOR PETOGEN USAGE

 Women who prefer to use contraception privately  When for health reasons pregnancy is undesirable and sterilization unacceptable  Have just had an abortion or miscarriage  Are any age, including teenagers and over 40  Women who smoke  Women in whom long-term progestogens are indicated i.e thromboembolic disorders  Women who lead irregular lifestyles

CONCLUSIONS Partnerships at all levels pay dividends i.e from the Ministries of Health, demand managers and buyers, right down to the clinic sisters and administrators at grass root level. By sharing basic information, knowledge and training, as well as providing materials for the exposure of the quality product and reliable supply basically guarantees co-operation form the various sectors involved in the acquisition and distribution of the critical contraceptive product.